Individual
LACEY FISK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1118 2ND AVE, FAIRBANKS, AK 99701-4228
(907) 456-6213
(907) 452-5925
Mailing address
1118 2ND AVE, FAIRBANKS, AK 99701-4228
(907) 456-6213
(907) 452-5925
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
120919
AK
Other
Enumeration date
04/11/2017
Last updated
04/11/2017
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